本文選題：難治性哮喘 + 支氣管熱成形術(shù)��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：背景:支氣管哮喘(哮喘)是一種常見的氣道慢性炎癥性疾病,以氣道高反應(yīng)性和可逆性氣流受限為特征,晚期可出現(xiàn)氣道重塑改變。對于多數(shù)的哮喘患者,通過吸入糖皮質(zhì)激素(ICS)或聯(lián)合長效β2-受體激動(dòng)劑(LABA)的規(guī)范治療可以達(dá)到良好控制;然而,約有5-10%的患者盡管經(jīng)過規(guī)范的藥物治療,癥狀仍難以控制,這些患者屬于難治性哮喘,其原因常與氣道重塑的存在相關(guān)。這部分患者疾病惡化風(fēng)險(xiǎn)增高、住院率及病死率增加、嚴(yán)重影響生活質(zhì)量、增加家庭和社會負(fù)擔(dān)。支氣管熱成形術(shù)(bronchial thermoplasty,BT)是近年來國際上在哮喘非藥物治療方面最重要的突破,其原理是通過支氣管鏡將射頻消融探頭置入支氣管腔內(nèi),將體外射頻發(fā)生器產(chǎn)生的熱能傳導(dǎo)至支氣管管壁,消融增生的支氣管平滑肌細(xì)胞,從而達(dá)到治療作用。國際上多項(xiàng)針對BT治療難治性哮喘的臨床研究結(jié)果顯示,BT可有效改善難治性哮喘患者癥狀、提高患者生活質(zhì)量、減少治療藥物使用。2010年4月,美國食品藥物監(jiān)督管理局(FDA)批準(zhǔn)了BT可用于治療18歲以上、應(yīng)用ICS和LABA控制不佳的重度持續(xù)性哮喘患者。2014年歐洲呼吸病學(xué)會和美國胸科協(xié)會的診治指南明確指出,BT可以應(yīng)用于治療成人的重癥哮喘。2014年2月支氣管熱成形術(shù)在我國正式獲得批準(zhǔn)可用于臨床治療重癥哮喘,但關(guān)于該技術(shù)對我國難治性哮喘患者治療的有效性和安全性數(shù)據(jù)尚缺乏,有待進(jìn)一步積累并明確。目的:分析支氣管熱成形術(shù)治療難治性哮喘在我國哮喘患者中的安全性及治療效果。方法:本研究分兩部分,第一部分:以2015年3—12月我院收治的6例難治性哮喘患者為研究對象,觀察這6例經(jīng)長期口服或吸入大劑量糖皮質(zhì)激素和長效β2-受體激動(dòng)劑規(guī)范治療后仍控制不佳的哮喘患者,經(jīng)支氣管熱成形術(shù)治療后的療效,觀察治療后3周內(nèi)不良反應(yīng)發(fā)生情況,評估治療后1年內(nèi)哮喘癥狀、哮喘急性發(fā)作就診次數(shù)、因哮喘急性發(fā)作住院次數(shù)、肺通氣功能、激素使用劑量和術(shù)后1年內(nèi)的并發(fā)癥等情況,對比患者BT治療前1年內(nèi)哮喘癥狀、哮喘急性發(fā)作就診次數(shù)、因哮喘急性發(fā)作住院次數(shù)、肺通氣功能和激素使用劑量等情況。第二部分:查閱2014年1月-2016年12月在我國雜志上已公開報(bào)道的經(jīng)BT治療的哮喘患者情況,其中上海市第十人民醫(yī)院(s)2例,廣州醫(yī)科大學(xué)附屬第一醫(yī)院(g)6例,中日友好醫(yī)院(z)12例;結(jié)合我院收治的6例患者的總體治療前后情況進(jìn)行綜述分析。結(jié)果:我院收治的6例患者術(shù)前及術(shù)后1年內(nèi)哮喘急性發(fā)作患者例數(shù)分別為6和5例,哮喘急性發(fā)作來院就診累計(jì)次數(shù)分別為30次和6次,因哮喘急性發(fā)作住院患者分別為5例和0例,累計(jì)住院次數(shù)分別為12次和0次;術(shù)后1年內(nèi)6例患者總哮喘急性發(fā)作就診次數(shù)、總因哮喘急性發(fā)作住院次數(shù)均較術(shù)前1年明顯下降;通過比較患者術(shù)前和術(shù)后1年的哮喘問卷調(diào)查發(fā)現(xiàn),患者的主觀癥狀明顯改善,經(jīng)過統(tǒng)計(jì)學(xué)分析(P0.05)具有統(tǒng)計(jì)學(xué)意義;通過比較患者術(shù)前和術(shù)后肺功能指標(biāo)和激素類藥物的使用情況,并經(jīng)過統(tǒng)計(jì)學(xué)分析(P0.05),考慮無統(tǒng)計(jì)學(xué)意義;關(guān)于術(shù)后并發(fā)癥情況,6例患者術(shù)后3周最常見不良反應(yīng)為咳嗽、咳痰量增加、喘息,多數(shù)在術(shù)后1周內(nèi)緩解,術(shù)后3周內(nèi)無嚴(yán)重不良事件發(fā)生,術(shù)后1年胸部CT檢查未見氣道結(jié)構(gòu)性改變,余未見任何與BT治療相關(guān)的不良反應(yīng)。結(jié)合同期其它醫(yī)院治療的20例患者進(jìn)行分析,經(jīng)我院BT治療的6例患者,治療效果與國內(nèi)其它醫(yī)院的效果相似。結(jié)論:對行支氣管熱成形治療的難治性哮喘患者經(jīng)過1年的隨訪觀察發(fā)現(xiàn),BT治療可以明顯改善患者的主觀癥狀、減少急性發(fā)作、改善常規(guī)藥物對哮喘的控制,但是對患者肺功能指標(biāo)以及激素類控制藥物的用量的影響,表現(xiàn)出個(gè)體間的差異;雖然在我院治療的患者只發(fā)生少數(shù)輕微的治療后短期并發(fā)癥,且控制較好,未出現(xiàn)嚴(yán)重的和長期的治療后不良反應(yīng),但是結(jié)合同期其它醫(yī)院治療的患者進(jìn)行分析,BT治療還是有一定治療風(fēng)險(xiǎn)的,需注意防范一些嚴(yán)重并發(fā)癥的發(fā)生;通過此項(xiàng)研究發(fā)現(xiàn)BT治療在中國人乃至亞洲人身上也能達(dá)到與歐美人相似的療效。
[Abstract]:Background: bronchial asthma (asthma) is a common chronic airway inflammatory disease characterized by airway hyperresponsiveness and reversible airflow limitation, and airway remodeling changes at the late stage. For most asthmatic patients, standardized treatment by inhaling Glucocorticoid (ICS) or combined with long effect beta 2- receptor agonists (LABA) can be achieved in good terms. Control; however, some patients with 5-10%, despite standardized drug treatment, are still difficult to control, and these are refractory asthma, which are often associated with the existence of airway remodeling. This part of the patients has increased risk of disease deterioration, increased hospitalization and mortality, seriously affected quality of life, and increased family and social burdens. Bronchial thermoplasty (BT) is the most important breakthrough in the international non drug treatment of asthma in recent years. The principle is that the radiofrequency ablation probe is inserted into the tracheal cavity by bronchoscope, and the heat energy produced by the radiofrequency generator in vitro is transmitted to the wall of the bronchial tube and the proliferating bronchial smooth muscle cells are ablated. Therapeutic effects. A number of clinical studies on BT treatment of refractory asthma have shown that BT can effectively improve the symptoms of refractory asthma, improve the quality of life, and reduce the use of drugs in April. The US Food and Drug Administration (FDA) approved BT for treatment over 18 years old and poor control of ICS and LABA. The guidelines for diagnosis and treatment of the.2014 European Respiratory Society and the American Thoracic Association clearly indicate that BT can be used in the treatment of adult severe asthma by February bronchoplasty in China, which is officially approved for clinical treatment of severe asthma in China, but it is related to the treatment of refractory asthma in our country. The data of effectiveness and safety are still scarce and need to be further accumulated and clear. Objective: to analyze the safety and therapeutic effect of bronchial thermo plasty in the treatment of asthma patients in China. Methods: This study is divided into two parts. The first part: 6 cases of refractory asthma treated in our hospital from 3 to December 2015 as the research object, The 6 cases of asthmatic patients with poor control after long term oral or inhaled high dose glucocorticoid and long effect beta 2- receptor agonist were treated with bronchial thermo plasty, and the adverse reactions were observed within 3 weeks after treatment. The symptoms of asthma in 1 years after treatment, the number of acute attacks of asthma, and asthma were evaluated. The number of acute episodes, pulmonary ventilation, hormone dosage and complications after 1 years were compared. The symptoms of asthma, the number of acute attacks of asthma, the number of hospitalization for acute attack of asthma, the ventilation function of the lung and the dosage of hormone were compared in the 1 years before BT treatment. The second part was in December in January 2014, in December. The cases of asthma treated by BT have been reported in China's magazine, including 2 cases of Shanghai Tenth People's Hospital (s), 6 cases of Guangzhou Medical University Affiliated Hospital (g), and 12 cases of Z, and 6 patients treated in our hospital were reviewed and analyzed before and after the total treatment. Results: 6 patients were treated before and after operation in our hospital. The number of patients with acute attack of asthma in the last 1 years were 6 and 5, and the cumulative number of hospitalization for acute attack of asthma was 30 and 6 respectively. The hospitalized patients with acute asthma were 5 and 0, respectively. The cumulative number of hospitalization was 12 and 0, and the number of acute attacks of asthma in 6 patients within 1 years after the operation was always due to acute asthma attack. The number of hospitalized patients was significantly lower than that of 1 years before the operation. By comparing the patients' asthma questionnaire before and after 1 years of operation, the subjective symptoms of the patients were obviously improved, and the statistical analysis (P0.05) was statistically significant. The use of lung function indexes and hormone drugs before and after the operation was compared, and the statistical analysis was made (P0 .05), there was no statistical significance. With regard to postoperative complications, the most common adverse reaction of 6 patients after 3 weeks of operation was cough, the amount of expectoration increased, and the majority of the patients were relieved within 1 weeks after the operation. No serious adverse events occurred within 3 weeks after the operation. No structural changes in the air tract were found in the chest CT examination for 1 years after the operation, and no adverse reaction associated with the treatment of BT was not seen. According to the analysis of 20 patients with other hospital treatment in the same period and 6 patients treated by BT in our hospital, the effect was similar to that of other hospitals in China. Conclusion: after 1 years of follow-up observation on the refractory asthma patients treated with bronchoplasty, the treatment of BT can improve the subjective symptoms of the patients and reduce the acute hair. To improve the control of asthma by conventional drugs, but the effects on the lung function index and the dosage of hormone controlled drugs showed individual differences; although only a few minor postoperative complications occurred in the patients treated in our hospital, and the control was better, there was no serious and long-term adverse reaction after treatment. According to the analysis of patients with other hospital treatment in the same period, BT treatment still has a certain risk of treatment. It is necessary to take precautions against some serious complications. Through this study, it is found that the treatment of BT can also be similar to the European and American people in the Chinese and Asian people.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R562.25

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